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Query: UMLS:C0277787 (stigma)
 13,352 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

More than 60,000 women in the United States have been diagnosed with AIDS, and millions of women worldwide are infected with HIV. Most of these women will die at an early age, leaving their children motherless. During their HIV illness, women confront the challenge of being both patient and family caregiver. Little research has explored this dual challenge. The authors conducted semistructured one-hour interviews with HIV-positive women that focused on the impact of the HIV diagnosis on the women's lives. Significant factors emerging from the interviews included the impact of stigma associated with HIV/AIDS, disbelief of the diagnosis, the lack of a guardian for their children, the paucity of women's support groups, and barriers associated with seeking services. All women exhibited evidence of clinical depression. A model for multidisciplinary intervention is proposed that focuses on women's needs within their family systems.
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PMID:Women living with HIV/AIDS: the dual challenge of being a patient and caregiver. 902 18

Touch is a powerful medium of social validation. Patients with skin disorders often experience social rejection when people avoid touching them, possibly fearing contagion or filth. We examined the psychologic impact of the stigma experience among 137 patients with moderate to severe psoriasis; 26.3 percent of patients reported that during the previous month they had experienced an episode when "people made a conscious effort not to touch them" because of their psoriasis. The stigmatized group did not have greater psoriasis severity than the non-stigmatized control group. However, in contrast to the non-stigmatized group, the stigmatized group had higher (P = 0.0003) depression scores (in the range for clinical depression, as measured by the Carroll Rating Scale for Depression), by stepwise logistic regression analysis using a wide range of psychopathologic measures as the independent variables. These findings underline the profound impact of the stigma experience in psoriasis, and possibly other dermatologic conditions that are associated with social stigma.
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PMID:Perceived deprivation of social touch in psoriasis is associated with greater psychologic morbidity: an index of the stigma experience in dermatologic disorders. 964 May 55

A pilot study of 29 patients for research on clinical depression employed the framework of cultural epidemiology to examine illness-related experience, meaning, behaviour with a Bengali version of the explanatory Model Interview Catalogue (EMIC). This report examined patterns of distress and stigma with reference to the most troubling patient-specified symptom. All subjects were psychiatric outpatients in the Institute of Psychiatry, Calcutta, and met Diagnostic and Statistical Manual (DSM)-IV criteria for a major depressive episode. Only 5 patients (17.2%) identified sadness as the most troubling problem, and 48.3% specified pains and other somatic symptoms instead. An internally consistent stigma scale with Cronbach's alpha of .67, comprised 13 items, was used to assess stigma. In addition to the scale score for each subject, the contribution of each item was reported and compared. A suggestive, though not significantly lower value of the stigma score for patients reporting somatic symptoms as most troubling, compared with sadness, was consistent with findings from prior studies showing a positive relationship between the magnitude of depression and stigma. These findings are discussed with reference to their impact on recognition and help seeking among patients, and recognition and management of depression by general practitioner. Culturally distinctive presentations and social contexts of depression and other mental illnesses should be addressed in professional training and public health communications.
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PMID:Prominence of symptoms and level of stigma among depressed patients in Calcutta. 1148 Sep 52

Disease and mood states are important determinants of quality of life (QOL). Low QOL, due to mood states, can be expected especially in psychiatric disorders such as depression. However, patients with seizure disorders may be even more affected because of the combined burden of physical episodes, psychiatric comorbidities, and psychosocial factors (e.g., stigma). In this study, we compare the quality of life in seizure disorders and clinical depression. Based on our earlier findings, we hypothesize that epilepsy patients fare better than patients with psychogenic, nonepileptic seizures (PNES), and we speculate that QOL in PNES is also lower relative to clinical depression. We estimate the relationships between type of seizures (epilepsy vs PNES), depression, and QOL (SF-36) using multiple regression, and we compare the SF-36 scores of patients with epilepsy and PNES (n=194) with the normative data for clinical depression using one-sample t tests. Our findings indicate that depression contributes to the poor QOL in both epilepsy and PNES, but the patients with PNES, even those without depression, have worse QOL compared with both the epilepsy patients and the depression norms. We conclude that evaluating and treating mood states is as important as treating PNES itself when caring for patients with PNES, and it might be the first step toward improving their QOL.
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PMID:Seizure disorders, depression, and health-related quality of life. 1475 Dec 7

There has been considerable interest recently in the relationship between depression and the workplace. This interest is driven by the growing recognition that depressive disorders are highly prevalent in the workplace and have an enormously negative impact on performance, productivity, absenteeism, and disability costs. A variety of clinical research with occupational-related samples has helped to define those at risk for depression and has led to a better understanding of the overlap of the construct of clinical depression with more longstanding occupational health and organizational psychology models such as stress, burnout, and job satisfaction. From an employer perspective, depression's impact remains largely unmitigated due to stigma, uncertainty about treatment's cost effectiveness, and lack of effective interventions delivered in a workplace setting. Progress in these areas is reviewed with suggestions for future directions.
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PMID:Depression and the workplace: a progress report. 1826 98

Russia has seen one of the world's fastest-growing HIV epidemics. Transmission risk behavior, HAART-taking, and psychosocial distress of the growing population of Russian people living with HIV (PLH) in the HAART era are understudied. Participants of a systematically-recruited cross-sectional sample of 492 PLH in St. Petersburg completed measures of sexual and drug injection practices, adherence, perceived discrimination, and psychosocial distress. Since learning of their status, 58% of participants had partners of HIV-negative or unknown serostatus (mean = 5.8). About 52% reported unprotected intercourse with such partners, with 30% of acts unprotected. Greater perceived discrimination predicted lower condom use. A 47% of IDU PLH still shared needles, predicted by having no primary partner, lower education, and more frequently-encountered discrimination. Twenty-five percentage of PLH had been refused general health care, 11% refused employment, 7% fired, and 6% forced from family homes. Thirty-nine percentage of participants had probable clinical depression, 37% had anxiety levels comparable to psychiatric inpatients, and social support was low. Of the 54% of PLH who were offered HAART, 16% refused HAART regimens, and 5% of those on the therapy took less than 90% of their doses. Comprehensive community services for Russian PLH are needed to reduce AIDS-related psychosocial distress and continued HIV transmission risk behaviors. Social programs should reduce stigma and discrimination, and promote social integration of affected persons and their families.
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PMID:People with HIV in HAART-era Russia: transmission risk behavior prevalence, antiretroviral medication-taking, and psychosocial distress. 2080 63

Despite the availability of many treatment options, depressive disorders remain a global public health problem. Even in affluent nations, 70% of reported cases either do not receive the recommended level of treatment or do not get treated at all, and this percentage does not reflect cases of depression that go unreported due to lack of access to health care, stigma, or other reasons. In developing countries, the World Health Organization estimates that <10% receive proper depression care due to poverty, stigma, and lack of governmental mental health resources and providers. Current treatments do not work for everyone, and even people who achieve remission face a high risk of recurrence and residual disability. The development of low-cost effective interventions that can serve either as initial therapy for mild symptoms or as adjunctive therapy for partial responders to medication is an immense unmet need. Positive activity interventions (PAIs) teach individuals ways to increase their positive thinking, positive affect, and positive behaviors. The majority of such interventions, which have obtained medium-size effect sizes, have been conducted with nondepressed individuals, but two randomized controlled studies in patients with mild clinical depression have reported promising initial findings. In this article, the authors review the relevant literature on the effectiveness of various types of PAIs, draw on social psychology, affective neuroscience and psychophamacology research to propose neural models for how PAIs might relieve depression, and discuss the steps needed to translate the potential promise of PAIs as clinical treatments for individuals with major and minor depressive disorders.
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PMID:Delivering happiness: translating positive psychology intervention research for treating major and minor depressive disorders. 2172 28

Frequently used in a pejorative sense, "disease mongering" connotes a widening of the diagnostic boundaries of illness. Pharmaceutical companies conduct disease awareness campaigns on the pretext of educating the public about the prevention of illness or the promotion of health. Encouraged by disease awareness advertisements, people gradually become filled with concern that they are ill and need medical treatment. As a result, pharmacotherapy is increasingly being applied to ever-milder conditions, leading to potentially unnecessary medication, wasted resources, and even adverse side effects. Among all fields of clinical medicine, psychiatry is undoubtedly the most vulnerable to the danger of disease mongering. In Japan, depression provides the most drastic example of the impact of disease awareness campaigns on the number of patients seeking treatment. Until the late 1990s, Japanese psychiatrists focused almost exclusively on psychosis and endogenous depression, the latter being severe enough to require conventional forms of antidepressants, known as tricyclic antidepressants, and even hospitalization. At this time, people's attitude toward depression was generally unfavorable. Indeed, the Japanese word for clinical depression, utubyo, has a negative connotation, implying severe mental illness. This situation, however, changed immediately after fluvoxiamine (Luvox-Fujisawa, Depromel-Meiji Seika), the first selective serotonin re-uptake inhibitor (SSRI) to receive approval in Japan, was introduced in 1999. In order to aid the drug's acceptance by the Japanese public, pharmaceutical companies began using the catchphrase kokoro no kaze, which literally means "a cold of the soul". Thus armed with this phrase, the pharmaceutical industry embarked on a campaign to lessen the stigma surrounding depression. According to national data from the Ministry of Health and Welfare, the number of patients with a diagnosis of mood disorder increased from 327,000 in 1999 to 591,600 in 2003. At the same time, antidepressant sales have sextupled, from\14.5 billion in 1998 to\87 billion in 2006, according to statistics from GlaxoSmithKline. Recently, the pharmaceutical industry has shifted its focus from depression to bipolar disorder. Historically, Japanese psychiatrists have been familiar with Emil Kraepelin's "manic depressive insanity" (1899), whose definition was much narrower than that of its contemporary counterpart, bipolar disorder. Thus far, perhaps due partly to the reference in Kraepelin's definition of "manic depressive" disorder, Japanese psychiatrists have rather conservatively prescribed mood stabilizers for persons with frequent mood swings. Japanese psychiatrists can learn a great deal from their experience with the aggressive marketing of antidepressants. In the case of depression, over-medication arguably did more harm than good. The same risk exists with bipolar disorder. Disease mongering may occur whenever the interests of a pharmaceutical company exceed the expected benefits from the proposed pharmacotherapy on those affected by the putative bipolar disorder. In cases that are not severe enough for aggressive medication, psychiatrists should propose natural alternatives, such as an alteration of lifestyle and psychotherapy.
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PMID:[Disease mongering and bipolar disorder in Japan]. 2235 6

Limited data exist regarding community attitudes and knowledge about clinical depression in rural India. We administered 159 questionnaires and 7 focus groups to Gujarati villagers to explore knowledge and beliefs about clinical depression. Quantitative data were analyzed for frequencies, nonparametric correlations, and principal components, whereas qualitative data were coded for prominent themes. Two groups of subjects emerged from our analysis: one "medically oriented" group that viewed depression as a medical condition and expressed optimism regarding its prognosis and one "spiritually oriented" group that expressed pessimism. Correlations emerged between etiological belief, degree of optimism, and associated stigma. The subjects were pessimistic when they attributed depression to a traumatic event, punishment from God, or brain disease but optimistic when depression was attributed to socioeconomic circumstances. Overall, the subjects were knowledgeable and open-minded toward depression and demonstrated curiosity and willingness to learn more. This study will help to inform future clinical and educational outreach in rural Gujarat.
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PMID:Knowledge and attitudes toward depression among community members in rural Gujarat, India. 2527 44

Third-trimester stillbirth affects approximately 2.6 million women worldwide each year. Although most stillbirths (98%) occur in low- and middle-income countries, most of the research on the impact of stillbirth and bereavement care has come from high-income countries. The impact of stillbirth ranges from stigma to disenfranchised grief, broken relationships, clinical depression, chronic pain, substance use, increased use of health services, employment difficulties, and debt. Appropriate bereavement care following a stillbirth is essential to minimise the negative socio-economic impact on parents and their families. This article presents the best practice points in stillbirth bereavement care, including taking an individualised and flexible approach. The latest published research, guidelines, and best practice points from high-income countries will be used and will highlight the gaps in the research which urgently need to be addressed. Research and investment in appropriate, respectful aftercare is needed to minimise the negative impact for parents.
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PMID:Care following stillbirth in high-resource settings: Latest evidence, guidelines, and best practice points. 2827 40


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